Skip to main content
Erschienen in: Indian Journal of Gastroenterology 4/2017

24.08.2017 | Original Article

Anesthesia in per-oral endoscopic myotomy: A large tertiary care centre experience

verfasst von: Santosh Darisetty, Zaheer Nabi, Mohan Ramchandani, Radhika Chavan, Rama Kotla, D. Nageshwar Reddy

Erschienen in: Indian Journal of Gastroenterology | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Background and Objectives

Per-oral endoscopic myotomy (POEM) is safe and efficacious for the management of achalasia cardia (AC). POEM is usually performed under general anesthesia in an endoscopy suite or operating theatre. The current study was conducted with the aim to analyse anesthetic management of patients with AC who underwent POEM at our institution.

Methods

We retrospectively analysed the data of patients with AC who underwent POEM at our institution from January 2013 to September 2016. All cases were performed in an endoscopy suite under supervision of an anesthesia management team. Pre-procedure endoscopic evacuation of esophagogastric contents was done in all cases. Management strategies used for gas-related adverse events and outcomes were assessed.

Results

Four hundred and eighty patients (median age 40 years, range 4–77 years) underwent POEM during the study period. The sub-types of AC were type I (163), type II (297), and type III (20). POEM was successfully completed in 97.5% patients. Gas-related events were noted in 30.6% cases including-capno-thorax in 1%, capno-peritoneum in 12.3%, retroperitoneal air in 16.5%, capno-mediastinum in 0.2%, and capno-pericardium in 0.4% patients. Significant rise in end tidal CO2 (> 45) and peak airway pressure were observed in 8.1% and 5.4% cases, respectively. Drainage was required in 12.3% patients. There was no occurrence of aspiration during or after POEM.

Conclusions

POEM could be safely performed in an endoscopy suite under supervision of an expert anesthesia management team. Gas-related adverse events were common during POEM and could be managed with a standardized approach.
Literatur
1.
Zurück zum Zitat Stavropoulos SN, Friedel D, Modayil R, Parkman HP. Diagnosis and management of esophageal achalasia. BMJ. 2016;354:i2785.CrossRefPubMed Stavropoulos SN, Friedel D, Modayil R, Parkman HP. Diagnosis and management of esophageal achalasia. BMJ. 2016;354:i2785.CrossRefPubMed
2.
Zurück zum Zitat Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108:1238–49.CrossRefPubMed Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108:1238–49.CrossRefPubMed
3.
Zurück zum Zitat Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.CrossRefPubMed Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.CrossRefPubMed
4.
Zurück zum Zitat Ramchandani M, Nageshwar Reddy D, Darisetty S, et al. Peroral endoscopic myotomy for achalasia cardia: treatment analysis and follow up of over 200 consecutive patients at a single center. Dig Endosc. 2016;28:19–26.CrossRefPubMed Ramchandani M, Nageshwar Reddy D, Darisetty S, et al. Peroral endoscopic myotomy for achalasia cardia: treatment analysis and follow up of over 200 consecutive patients at a single center. Dig Endosc. 2016;28:19–26.CrossRefPubMed
5.
Zurück zum Zitat Talukdar R, Inoue H, Nageshwar Reddy D. Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc. 2015;29:3030–46. Talukdar R, Inoue H, Nageshwar Reddy D. Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc. 2015;29:3030–46.
6.
Zurück zum Zitat Akintoye E, Kumar N, Obaitan I, Alayo QA, Thompson CC. Peroral endoscopic myotomy: a meta-analysis. Endoscopy. 2016;48:1059–68.CrossRefPubMed Akintoye E, Kumar N, Obaitan I, Alayo QA, Thompson CC. Peroral endoscopic myotomy: a meta-analysis. Endoscopy. 2016;48:1059–68.CrossRefPubMed
7.
Zurück zum Zitat Werner YB, Costamagna G, Swanstrom LL, et al. Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut. 2016;65:899–906.CrossRefPubMed Werner YB, Costamagna G, Swanstrom LL, et al. Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut. 2016;65:899–906.CrossRefPubMed
8.
Zurück zum Zitat Parshad R, Devana SK, Panchanatheeswaran K, et al. Clinical, radiological and functional assessment of pulmonary status in patients with achalasia cardia before and after treatment. Eur J Cardiothorac Surg. 2012;42:e90–5.CrossRefPubMed Parshad R, Devana SK, Panchanatheeswaran K, et al. Clinical, radiological and functional assessment of pulmonary status in patients with achalasia cardia before and after treatment. Eur J Cardiothorac Surg. 2012;42:e90–5.CrossRefPubMed
9.
Zurück zum Zitat Makharia GK, Seith A, Sharma SK, et al. Structural and functional abnormalities in lungs in patients with achalasia. Neurogastroenterol Motil. 2009;21:603–8. e20CrossRefPubMed Makharia GK, Seith A, Sharma SK, et al. Structural and functional abnormalities in lungs in patients with achalasia. Neurogastroenterol Motil. 2009;21:603–8. e20CrossRefPubMed
10.
Zurück zum Zitat Werner YB, von Renteln D, Noder T, et al. Early adverse events of per-oral endoscopic myotomy. Gastrointest Endosc. 2017;85:708–18.CrossRefPubMed Werner YB, von Renteln D, Noder T, et al. Early adverse events of per-oral endoscopic myotomy. Gastrointest Endosc. 2017;85:708–18.CrossRefPubMed
11.
Zurück zum Zitat Zhang XC, Li QL, Xu MD, et al. Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis. Endoscopy. 2016;48:967–78.CrossRefPubMed Zhang XC, Li QL, Xu MD, et al. Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis. Endoscopy. 2016;48:967–78.CrossRefPubMed
12.
Zurück zum Zitat Yang S, Zeng MS, Zhang ZY, Zhang HL, Liang L, Zhang XW. Pneumomediastinum and pneumoperitoneum on computed tomography after peroral endoscopic myotomy (POEM): postoperative changes or complications? Acta Radiol. 2015;56:1216–21.CrossRefPubMed Yang S, Zeng MS, Zhang ZY, Zhang HL, Liang L, Zhang XW. Pneumomediastinum and pneumoperitoneum on computed tomography after peroral endoscopic myotomy (POEM): postoperative changes or complications? Acta Radiol. 2015;56:1216–21.CrossRefPubMed
13.
Zurück zum Zitat Pannu D, Yang D, Abbitt PL, Draganov PV. Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy. Gastrointest Endosc. 2016;84:408–15.CrossRefPubMed Pannu D, Yang D, Abbitt PL, Draganov PV. Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy. Gastrointest Endosc. 2016;84:408–15.CrossRefPubMed
14.
Zurück zum Zitat Tanaka E, Murata H, Minami H, Sumikawa K. Anesthetic management of peroral endoscopic myotomy for esophageal achalasia: a retrospective case series. J Anesth. 2014;28:456–9.CrossRefPubMed Tanaka E, Murata H, Minami H, Sumikawa K. Anesthetic management of peroral endoscopic myotomy for esophageal achalasia: a retrospective case series. J Anesth. 2014;28:456–9.CrossRefPubMed
15.
Zurück zum Zitat Yang D, Pannu D, Zhang Q, White JD, Draganov PV. Evaluation of anesthesia management, feasibility and efficacy of peroral endoscopic myotomy (POEM) for achalasia performed in the endoscopy unit. Endosc Int Open. 2015;3:E289–95.CrossRefPubMedPubMedCentral Yang D, Pannu D, Zhang Q, White JD, Draganov PV. Evaluation of anesthesia management, feasibility and efficacy of peroral endoscopic myotomy (POEM) for achalasia performed in the endoscopy unit. Endosc Int Open. 2015;3:E289–95.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Goudra B, Singh PM, Gouda G, Sinha AC. Peroral endoscopic myotomy-initial experience with anesthetic management of 24 procedures and systematic review. Anesth Essays Res. 2016;10:297–300.CrossRefPubMedPubMedCentral Goudra B, Singh PM, Gouda G, Sinha AC. Peroral endoscopic myotomy-initial experience with anesthetic management of 24 procedures and systematic review. Anesth Essays Res. 2016;10:297–300.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Ramchandani M, Nageshwar Reddy D. Peroral endoscopic myotomy: technique of mucosal incision. Clin Gastroenterol Hepatol. 2014;12:900–1. Ramchandani M, Nageshwar Reddy D. Peroral endoscopic myotomy: technique of mucosal incision. Clin Gastroenterol Hepatol. 2014;12:900–1.
18.
Zurück zum Zitat Hoppo T, Thakkar SJ, Schumacher LY, et al. A utility of peroral endoscopic myotomy (POEM) across the spectrum of esophageal motility disorders. Surg Endosc. 2016;30:233–44.CrossRefPubMed Hoppo T, Thakkar SJ, Schumacher LY, et al. A utility of peroral endoscopic myotomy (POEM) across the spectrum of esophageal motility disorders. Surg Endosc. 2016;30:233–44.CrossRefPubMed
19.
Zurück zum Zitat Hungness ES, Sternbach JM, Teitelbaum EN, Kahrilas PJ, Pandolfino JE, Soper NJ. Per-oral endoscopic Myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann Surg. 2016;264:508–17.CrossRefPubMed Hungness ES, Sternbach JM, Teitelbaum EN, Kahrilas PJ, Pandolfino JE, Soper NJ. Per-oral endoscopic Myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann Surg. 2016;264:508–17.CrossRefPubMed
20.
Zurück zum Zitat Khashab MA, El Zein M, Kumbhari V, et al. Comprehensive analysis of efficacy and safety of peroral endoscopic myotomy performed by a gastroenterologist in the endoscopy unit: a single-center experience. Gastrointest Endosc. 2016;83:117–25.CrossRefPubMed Khashab MA, El Zein M, Kumbhari V, et al. Comprehensive analysis of efficacy and safety of peroral endoscopic myotomy performed by a gastroenterologist in the endoscopy unit: a single-center experience. Gastrointest Endosc. 2016;83:117–25.CrossRefPubMed
21.
Zurück zum Zitat Patel KS, Calixte R, Modayil RJ, Friedel D, Brathwaite CE, Stavropoulos SN. The light at the end of the tunnel: a single-operator learning curve analysis for per oral endoscopic myotomy. Gastrointest Endosc. 2015;81:1181–7.CrossRefPubMed Patel KS, Calixte R, Modayil RJ, Friedel D, Brathwaite CE, Stavropoulos SN. The light at the end of the tunnel: a single-operator learning curve analysis for per oral endoscopic myotomy. Gastrointest Endosc. 2015;81:1181–7.CrossRefPubMed
23.
Zurück zum Zitat Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanstrom LL. Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc. 2013;77:719–25.CrossRefPubMed Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanstrom LL. Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc. 2013;77:719–25.CrossRefPubMed
24.
Zurück zum Zitat Saxena P, Pippenger R, Khashab MA. Preventing aspiration during peroral endoscopic myotomy. J Anesth. 2014;28:959.CrossRefPubMed Saxena P, Pippenger R, Khashab MA. Preventing aspiration during peroral endoscopic myotomy. J Anesth. 2014;28:959.CrossRefPubMed
25.
Zurück zum Zitat Wang J, Tan N, Xiao Y, et al. Safety and efficacy of the modified peroral endoscopic myotomy with shorter myotomy for achalasia patients: a prospective study. Dis Esophagus. 2015;28:720–7.CrossRefPubMed Wang J, Tan N, Xiao Y, et al. Safety and efficacy of the modified peroral endoscopic myotomy with shorter myotomy for achalasia patients: a prospective study. Dis Esophagus. 2015;28:720–7.CrossRefPubMed
26.
Zurück zum Zitat Committee AT, Pannala R, Abu Dayyeh BK, et al. Per-oral endoscopic myotomy (with video). Gastrointest Endosc. 2016;83:1051–60.CrossRef Committee AT, Pannala R, Abu Dayyeh BK, et al. Per-oral endoscopic myotomy (with video). Gastrointest Endosc. 2016;83:1051–60.CrossRef
27.
Zurück zum Zitat Banks-Venegoni AL, Desilets DJ, Romanelli JR, Earle DB. Tension capnopericardium and cardiac arrest as an unexpected adverse event of peroral endoscopic myotomy (with video). Gastrointest Endosc. 2015;82:1137–9.CrossRefPubMed Banks-Venegoni AL, Desilets DJ, Romanelli JR, Earle DB. Tension capnopericardium and cardiac arrest as an unexpected adverse event of peroral endoscopic myotomy (with video). Gastrointest Endosc. 2015;82:1137–9.CrossRefPubMed
28.
Zurück zum Zitat Desborough JP. The stress response to trauma and surgery. Br J Anesth. 2000;85:109–17.CrossRef Desborough JP. The stress response to trauma and surgery. Br J Anesth. 2000;85:109–17.CrossRef
Metadaten
Titel
Anesthesia in per-oral endoscopic myotomy: A large tertiary care centre experience
verfasst von
Santosh Darisetty
Zaheer Nabi
Mohan Ramchandani
Radhika Chavan
Rama Kotla
D. Nageshwar Reddy
Publikationsdatum
24.08.2017
Verlag
Springer India
Erschienen in
Indian Journal of Gastroenterology / Ausgabe 4/2017
Print ISSN: 0254-8860
Elektronische ISSN: 0975-0711
DOI
https://doi.org/10.1007/s12664-017-0782-0

Weitere Artikel der Ausgabe 4/2017

Indian Journal of Gastroenterology 4/2017 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.